A note on EMTALA: if I had a dime for every time I witnessed one of the "suburban" hospitals try to dump a laboring patient from the "inner-city" hospital I'd have enough money to go clothes shopping. The medicaid patients would simply show up at the hospital of their choosing when they went into labor, even though they got their prenatal care at the "inner city" hospital, saying things like, "I didn't think I'd making it to my hospital in time." Was is frustrating to have "drop ins" (as they were called) show up on the door step with no records or forewarning? Sure it was. But how did the hospitals respond to this phenomenon? They punished the hell out of them, in any and every way they could think of. I witnessed many conversations about how to skirt EMTALA and get them the hell out of there. There were many intricate conversations on what constituted "active labor" and could this "drop in" be defined as early labor so they could send her out the door back to where she "belonged." Some of this was raciscm, most assuredly it was classiscm, some of it was just the inconvenience of dealing with the unfamiliar. But on every level, it was wrong. If insured, middle-class ladies think they get mistreated in birth (and they do), try being poor and Black, or a refugee, or someone who doesn't speak English, or a teenager of any race.
I've been asking myself for years, if I had a practice serving women, what would it look like? How would it be different? How would it be better? This is such a hard question. If it was so easy to overcome the currents of cultural belief, practice standards, tort reform, malpractice law, state regulations, governing boards, the ire of your peers, etc., surely someone would have done it by now and created this ideal practice. So far, the best examples I've seen are the underground midwives who practice illegally, always glancing over their shoulders, always risking their asses. My choice seemed to be, become a certified nurse midwife and conform or practice underground at risk to myself and my family. Couple that with the fact that the cultural pendulum has swung so far that when my daughters go in for their first prenatal visit, the docs will probably automatically ask what day they want their c/sections scheduled for. I can see things getting that bad. Maybe I'm just 7 months pregnant, deranged from the heat, and cranky.